The present invention relates, in general, to an illuminated retractor and, in particular, to a new and useful illuminated retractor for creating a working space for dissecting instruments in support of a surgical procedure such as rectal examination or for the removal of polyps or hemorrhoids or other types of procedures which require the illumination and access to tissue in the rectal area of a patient.
In certain surgical procedures, it is necessary to remove a section of tissue from a patient. For example, a polyp, fistula or hemorrhoid may be removed in a physician""s office. As a result of the increased interest in reducing the costs of medical care, more procedures are being performed on an outpatient basis. In many instances hospitalization or in patient surgery is not required. Various specialized retractors are available and although they provide the physician with access to the desired tissue, a separate source of illumination is often required.
In a rectal examination, it is important to provide reliable access to the desired tissue by retracting the tissue around the rectum. Once this tissue is retracted, it is important to provide access to the desired tissue. Currently, a Fansler style retractor and a Hill-Ferguson style retractor are available to provide access to the desired tissue. A Fansler style retractor consists generally of an elongate tubular member with a channel cut at the top position and a handle that is attached to a flange on the proximal end of the tubular member opposite from the channel. The retractor also preferably includes a removable obturator for use therewith. The Hill-Ferguson style retractor is typically a non-lighted retractor having a semi-circular cross section and a generally bullet shaped distal end portion. The Hill-Ferguson style retractor allows the physician to access a larger area of tissue in order to treat larger hemorrhoids or polyps. With these devices, the surgeon provides a separate source of illumination and the handle is oriented generally perpendicular to the lengthwise dimension of the retractor. Alternately, Electro-Surgical Instrument Company of Rochester N.Y., U. S. A. offers colo-rectal retractors that are capable of utilizing fiber-optic illumination to provide a directed light at the end of the fiber optic cable.
Currently, the physician typically uses a separate light source such as a head-mounted light or a separate lighted instrument to illuminate the desired tissue. Because the available tissue opening is relatively small, it is desirable that the number and size of instruments be kept to a minimum. It is also desirable to provide a source of light inside the retracted tissue area to illuminate the tissue of interest without obstructing the view of the surgeon. Additionally, the use of external illumination or light from the end of a source of directed light may cause shadows that reduce the surgeon""s ability to view the desired area.
The present invention overcomes the disadvantages of the prior art. As shown in the drawings, the present invention provides an illuminated retractor for illuminating the space internally of the sphincter and anal canal without significantly reducing the working space for the physician.
As used herein, reference to the distal end portion of an element is the end portion of an element that is spaced apart from the handle member and reference to the proximal end portion of an element is the end portion of an element that is generally adjacent to or closer to the handle member of the preferred form of the present invention
In a contemplated procedure for examining the rectum of a patient, the physician slowly inserts the retractor with the removable obturator inserted therein into the rectum of the patient by gradually stretching the sphincter until the cylindrical portion of the retractor and the distal end portion of the obturator enter the anal canal to expose the rectum. With the present invention, the obturator may then be removed and the tissue along and inwardly of the sphincter may be illuminated without the insertion of additional instruments and without the use of a head-mounted light that only illuminates a limited amount of the interior tissue.
The obturator of an embodiment of the present invention is a generally bullet shaped member that includes a slotted surface along one side thereof. In the preferred form of the present invention, the slotted surface is sized to allow the source of illumination to extend along the interior surface of the retractor as the assembly is inserted into the patient. The obturator includes a rounded distal end and an enlarged circumferential contact member to contact the enlarged proximal end portion of the retractor. The obturator further includes a proximal handle member to allow for the insertion and removal of the obturator into and from the retractor.
The illuminated retractor provides a large, well illuminated surgical field, where the illumination preferably extends the substantial length of the retractor within the space created by the retractor. With the tissue thus exposed, the physician uses additional tools and/or their fingers to locate the tissue of interest. If the physician is treating a hemorrhoid or polyp, they may easily insert the desired tool to remove and/or biopsy the desired portion of tissue without having to manipulate a source of illumination. The retractor also includes an open channel along the lengthwise dimension thereof that allows a selected portion of the tissue along the lengthwise dimension of the retractor to be exposed and substantially illuminated during the procedure.
The illuminated surgical retractor preferably has an elongate handle member that includes a plurality of finger grip members. The distal end portion of the handle member is rigidly attached to a first rod member. The first rod member is a relatively short cylindrical member that connects to an illumination fitting. The illumination fitting is used to interconnect the second elongate member of the retractor to a source of illumination. The illumination fitting is rigidly connected to a second rod member that is rigidly attached to a cylindrical member of the retractor. The first rod member, illumination fitting and the second rod member form a rigid interconnection between the handle member and the cylindrical member so the handle member is oriented at an angle greater than 90 degrees with respect to the lengthwise dimension of the cylindrical member. The handle member is preferably contoured to be gripped by the operating physician and is interconnected to the first elongate section even more preferably at an obtuse angle with respect to the lengthwise dimension of the first elongate section, thus permitting one-handed use by the physician. The handle member permits the retractor to be lifted and rotated at any desired angle to illuminate the tissue of interest.
The cylindrical member includes a first outer elongate section and a second inner elongate section. The first elongate section is preferably a generally cylindrical member having a radius in cross section that is preferably greater than 180 degrees. The first elongate section also preferably includes an operating channel extending lengthwise therealong and has a smooth and rounded distal end portion, an enlarged and tapered proximal end portion and a cylindrical elongate middle section. The interior of the first elongate section is preferably a reflective and/or mirrored surface. The operating channel is preferably located on the surface of the cylindrical member opposite to the connection with second rod member and the handle member. The distal end portion of the first elongate section preferably has a rounded shape or a smoothly radiused surface that allows the retractor, in combination with the obturator, to be pushed into the tissue by the physician and thrust forward and maneuvered into the rectum of the patient. The proximal end portion of the cylindrical member extends outwardly from the middle section to form an enlarged surface to assist in the insertion of tools into the retractor and to push tissue away from the proximal end portion of the retractor. The first elongate section preferably functions to transfer the lifting, manipulation and/or insertion force from the handle member to the tissue of the patient.
The second elongate section preferably includes a substantially transparent member, such as a light panel or fiber. The second elongate section includes an elongate proximal end portion and a second elongate distal end portion. The second elongate section may also include an insert member that ensures that the transparent member is spaced apart from the inner surface of the first elongate section and a distal post member to retain the distal end portion of the second elongate section adjacent to the interior of the first elongate section. The second elongate section preferably functions to perform the illumination feature of the present invention to substantially illuminate the entire length of the tissue along the first elongate member. The insert member, if used, preferably includes a mirrored or reflective surface thereon that further reflects the illumination from the transparent member to the desired tissue areas.
The distal end portion of the second elongate section preferably has a rounded shape or, alternatively, a smoothly radiused pointed shape with a slot thereon to receive a post member therein. The shape of the slot in the second elongate section distal end portion is preferably complementary to the shape of the post extending inwardly from the interior surface of the first elongate section so that, when the first and second elongate sections are connected, the second elongate section is preferably securely retained adjacent to and spaced apart from the sidewall of the first elongate section. Additionally, the distal end portion of the second elongate section may also be configured to direct light forwardly of the retractor during use.
In order to enhance the reflective qualities of the illuminated retractor, the inner surface of the first elongate section may preferably include a mirrored surface thereon. Also, the second elongate section may preferably have a machined micro-lens surface thereon that refracts the light forwardly and/or sideways at a desired angle. The mirrored surface of the first elongate section and the machined surface of the second elongate inner surface function to minimize the light intensity loss of the light energy that is provided to the surgical field by the illuminated retractor. For example, the second elongate section may be formed so that the light is transmitted at a forward angle that is between about 15 and 75 degrees and more preferably between about 30 and 60 degrees relative to the second elongate section while also scattering the illumination to the sides slong the length of the first elongate section of the retractor as desired.
The preferred form of the retractor also includes an illumination connector between the handle member and the first and second elongate sections. This connector is preferably a twist type of connector such that the proximal end portion of the second elongate section is secured therein when the connector is rotated. This connection is preferably simple to make, such as by a three-quarter turn, and is secure to ensure that the second elongate section remains attached to the retractor. The connector also connects the light source to the second elongate section to ensure that the light energy travels from the light source; through the connector and into the second elongate section. The light energy fills the second elongate section and turns the second elongate section into a xe2x80x9clight pipe.xe2x80x9d The light energy is, in turn, radiated from the second elongate section onto the tissue exposed by the retractor. In this manner, light can be provided from the light source via the optical cable to the illumination input end portion of the second elongate section so that the second elongate section is illuminated, which results in an illuminated surgical field.
In an alternate form of the present invention, the illuminated surgical retractor preferably has an elongate handle member that is rigidly attached to a first rod member. The first rod member is a relatively short cylindrical member that connects to an illumination fitting. The illumination fitting is used to interconnect the second elongate member of the retractor to a source of illumination. The illumination fitting is rigidly connected to a second rod member that is rigidly attached to a cylindrical member of the retractor. The first rod member, illumination fitting and the second rod member form a rigid interconnection between the handle member and the cylindrical member so the handle member is oriented at an obtuse angle with respect to the lengthwise dimension of the cylindrical member. The handle member is preferably contoured to be gripped by the operating physician and is interconnected to the first elongate section at the proximal end portion of the first elongate section, thus permitting one-handed use by the physician. The handle member permits the retractor to be lifted and rotated at any desired angle to illuminate the tissue of interest.
The cylindrical member of the alternate embodiment includes a first outer elongate section and a second inner elongate section. The first elongate section is preferably a generally cylindrical member having a radius of approximately 180 degrees in cross section and includes an operating channel extending lengthwise therealong with a smooth and rounded closed distal end portion, an open proximal end portion and a cylindrical elongate middle section. The interior of the first elongate section is preferably a reflective and/or mirrored surface. The operating channel is preferably located on the interior surface of the cylindrical member. The distal end portion of the first elongate section preferably has a rounded and generally bullet shape that allows the retractor, without an obturator, to be pushed into the tissue by the physician and then thrust forward and maneuvered into the rectum of the patient. The proximal end portion of the cylindrical member extends outwardly from the middle section to form an enlarged surface to assist in the insertion of tools into the retractor and to push tissue away from the proximal end portion of the retractor. The first elongate section preferably functions to transfer the lifting, manipulation and/or insertion force from the handle member to the tissue of the patient.
The second elongate section of the alternate embodiment preferably includes a substantially transparent member, such as a light panel or fiber. The second elongate section includes an elongate proximal end portion and a second elongate distal end portion. The second elongate section may also include a distal post member to retain the distal end portion of the second elongate section adjacent to the interior of the first elongate section. The second elongate section preferably functions to perform the illumination feature of the present invention and an insert member, if used, preferably includes a mirrored or reflective surface thereon that further reflects the illumination from the transparent member to the desired tissue areas.
The distal end portion of the alternate embodiment of the second elongate section preferably has a rounded shape or, alternatively, a smoothly radiused pointed shape with a slot thereon to receive a post member therein. The shape of the slot in the second elongate section distal end portion is preferably complementary to the shape of the post extending inwardly from the interior surface of the first elongate section so that, when the first and second elongate sections are connected, the second elongate section is securely retained adjacent to the sidewall of the first elongate section.
A further feature of the preferred form of the present invention is that the proximal end portion or heal portion of the illuminated retractor is formed to shield the user from the light created by the distal end portion of the second elongate section. Additionally, the first elongate section may include a light shield along the shaft portion thereof to shield the user from the light emitted from the second elongate section.
A further feature of the heal portion of the second elongate section of the present invention is that at least a portion of the shaft shaped portion and/or the proximal end portion of the second elongate section is preferably spaced apart from at least a portion of the first elongate section to ensure that there is no heat buildup between these elements of the illuminated surgical retractor.